Cost-effectiveness of empagliflozin as a treatment for heart failure with reduced ejection fraction: an analysis from the Chinese healthcare perspective

Lin, Xin; Lin, Minghua; Liu, Maobai; Huang, Wanjun; Nie, Xuekun; Chen, Zichun; Zheng, Bin

doi:10.21037/jtd-22-463

Cited by 16 publications

(17 citation statements)

References 21 publications

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“…The addon empagliflozin treatment for HFrEF was a cost-effective choice in Thailand, and it also considered adverse reaction events, including urinary tract infections Frontiers in Pharmacology frontiersin.org (Krittayaphong and Permsuwan, 2022). Empagliflozin in HFrEF also generated advantages in cost-effectiveness in the total, diabetic, and non-diabetic populations in China (Lin et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Tang

Sang²

2022

Front. Pharmacol.

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Objective: EMPEROR-Reduced and EMPEROR-Preserved studies showed the benefits of empagliflozin along with a reduction in cardiovascular death or hospitalisation for heart failure (HF). Our aim was to evaluate the economics and effectiveness of adding empagliflozin to the standard therapy for HF with reduced ejection fraction (HFrEF) and HF preserved ejection fraction (HFpEF) in China.Methods: A multistate Markov model was constructed to yield the clinical and economic outcomes of adding empagliflozin to the standard therapy for 65-year-old patients with HFrEF and HFpEF. A cost-utility analysis was conducted, mostly derived from the EMPEROR-Reduced study, EMPEROR-Preserved study, and national statistical database. All costs and outcomes were discounted at the rate of 5% per annum. The primary outcomes were total and incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were also performed.Results: In the HFrEF population, the 10-year incremental cost was $827.52 and the 10-year incremental QALY was 0.15 QALYs, resulting in an ICER of $5,612.06/QALY, which was below the WTP of $12,652.5/QALY. In the HFpEF population, compared with the control group, the incremental cost was $1,271.27, and the incremental QALY was 0.11 QALYs, yielding an ICER of 11,312.65 $/QALY, which was also below the WTP of $12,652.5/QALY. In the HFrEF and HFpEF populations, the results of a one-way sensitivity analysis showed that the risk of cardiovascular death in both groups was the most influential parameter. In the HFrEF population, a probability sensitivity analysis (PSA) revealed that when the WTP thresholds were $12,652.5/QALY and $37,957.5/QALY, the probabilities of being cost-effective with empagliflozin as an add-on were 59.4% and 72.6%, respectively. In the HFpEF population, the PSA results revealed that the probabilities of being cost-effective with empagliflozin as an add-on were 53.1% and 72.2%, respectively.Conclusion: Considering that the WTP threshold was $12,652.5/QALY, adding empagliflozin to standard therapy was proven to be a slightly more cost-effective option for the treatment of HFrEF and HFpEF from a Chinese healthcare system perspective, which promoted the rational use of empagliflozin for HF.

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Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Tang

Sang²

2022

Front. Pharmacol.

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“…Cost-effectiveness analyses of the add-on empagliflozin in HFrEF had also been proved to be cost-effective in China, the Asia-Pacific Region, and Thailand (30)(31)(32), but at the local Thai threshold of 4,773.27 $/QALY, adding empagliflozin to standard therapy yielded a QALY gain of 0.05 at an increased total cost of $622.49 compared to standard therapy alone (ICER: 11,809 $/QALY gained), in which empagliflozin was not a cost-effective add-on treatment for patients with HFpEF (32). We thought the local Thai threshold was much lower than our WTP.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of adding empagliflozin to the standard therapy for Heart Failure with Preserved Ejection Fraction from the perspective of healthcare systems in China

Jiang

Xie

2022

Front. Cardiovasc. Med.

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BackgroundThe Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction (EMPEROR-Preserved) is the first randomized controlled trial to provide promising evidence on the efficacy of adding empagliflozin to the standard therapy in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), but the cost-effectiveness of add-on empagliflozin treatment remains unclear.MethodA Markov model using data from the EMPEROR-Preserved trial and national database was constructed to assess lifetime costs and utility from a China healthcare system perspective. The time horizon was 10 years and a 5% discount rate was applied. Incremental cost-effectiveness ratio (ICER) against willingness to pay (WTP) threshold was performed to evaluate the cost-effectiveness. A series of sensitivity analyses was applied to ensure the robustness of the results.ResultsCompared to standard therapy, the increased cost of adding empagliflozin from $4,645.23 to $5,916.50 was associated with a quality-adjusted life years (QALYs) gain from 4.70 to 4.81, projecting an ICER of $11,292.06, which was lower than a WTP threshold of $12,652.5. Univariate sensitivity analysis revealed that the parameters with the largest impact on ICER were cardiovascular mortality in both groups, followed by the cost of empagliflozin and the cost of hospitalization for heart failure. Probabilistic sensitivity analysis indicated that when the WTP threshold was $12,652.5 and $37,957.5, the probability of being cost-effective for adding empagliflozin was 52.7% and 67.6%, respectively. Scenario analysis demonstrated that the cost of empagliflozin, the cost of hospitalization for heart failure, NYHA functional classes, and time horizon had a greater impact on the ICER.ConclusionAt a WTP threshold of $12,652.5, the add-on empagliflozin treatment for HFpEF was cost-effective in healthcare systems in China, which promoted the rational use of empagliflozin for HFpEF.

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“…[34][35][36][37] Cost-utility analyses of the add-on empagliflozin in HFrEF had also been proved to be cost-effective in China, Asia-Pacific region, and Thailand. [38][39][40] The adjunct use of SGLT2is to standard therapy among HFrEF patients in China was a cost-effective option. However, there was little evidence on the cost-utility of the add-on SGLT2is treatment for HFpEF and HFmrEF.…”

Section: Discussionmentioning

confidence: 99%

“…Dapagliflozin in HFrEF have generated advantages in cost‐effectiveness in China, United States, Australia, Egypt, and Asia‐Pacific region 34–37 . Cost‐utility analyses of the add‐on empagliflozin in HFrEF had also been proved to be cost‐effective in China, Asia‐Pacific region, and Thailand 38–40 . The adjunct use of SGLT2is to standard therapy among HFrEF patients in China was a cost‐effective option.…”

Section: Discussionmentioning

confidence: 99%

Cost‐utility analysis of add‐on dapagliflozin in heart failure with preserved or mildly reduced ejection fraction

Tang

Sang

2023

ESC Heart Failure

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Aims The DELIVER study demonstrates a significant improvement in cardiovascular death or hospitalization for heart failure among heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF).Cost‐utility of the adjunct use of dapagliflozin to standard therapy among patients with HFpEF or HFmrEF remains unclear. Methods and results A five‐state Markov mode was constructed to project health and clinical outcomes of the adjunct use of dapagliflozin to standard therapy among 65‐year‐old patients with HFpEF or HFmrEF. A cost‐utility analysis was performed based on the DELIVER study and national statistical database. The cost and utility was inflated to 2022 by the usual discount rate of 5%. The primary outcomes were total cost and quality‐adjusted life‐years (QALYs) per patients as well as the incremental cost‐effectiveness ratio. Sensitivity analyses were also applied. Over a 15 year lifetime horizon, the average cost per patient was $7245.77 and $5407.55 in the dapagliflozin group and the standard group, along with an incremental cost of $1838.22. The average QALYs per patient was 6.00 QALYs and 5.84 QALYs in the dapagliflozin group and the standard group, along with an incremental QALYs of 0.15 QALYs, resulting in the incremental cost‐effectiveness ratio of $11 865.33/QALY, which was below the willingness‐to‐pay (WTP) of $12 652.5/QALY. The univariate sensitivity analysis indicated the cardiovascular death in both group was the most sensitive variable. Probability sensitivity analysis revealed that when the WTP thresholds were $12 652.5/QALY and $37 957.5/QALY, the probabilities of being cost‐effective with dapagliflozin as an add‐on were 54.6% and 71.6%, respectively. Conclusions From a public healthcare system perspective, the adjunct use of dapagliflozin to standard therapy among patients with HFpEF or HFmrEF generated advantages in cost‐effectiveness in China at a WTP of $12 652.5/QALY, which promoted the rational use of dapagliflozin for heart failure.

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Cost-effectiveness of empagliflozin as a treatment for heart failure with reduced ejection fraction: an analysis from the Chinese healthcare perspective

Cited by 16 publications

References 21 publications

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Cost-effectiveness of adding empagliflozin to the standard therapy for Heart Failure with Preserved Ejection Fraction from the perspective of healthcare systems in China

Cost‐utility analysis of add‐on dapagliflozin in heart failure with preserved or mildly reduced ejection fraction

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